Jun 26, 2015 - 673 State Tobacco Control Program Spending â United. States ... MMWR Morb Mortal Wkly Rep 2015;64:[inclusive page numbers]. .... diagnosed HIV infection, by jurisdictionâ â United States, 2012 ... Kentucky ...... HIV infection, by testing setting and site type and race/ethnicity â 61 health departments.
Morbidity and Mortality Weekly Report Weekly / Vol. 64 / No. 24
June 26, 2015
Prevalence of Diagnosed and Undiagnosed HIV Infection — United States, 2008–2012
National HIV Testing Day — June 27, 2015 National HIV Testing Day, June 27, promotes the importance of testing in detecting, treating, and preventing human immunodeficiency virus (HIV) infection. HIV testing is the essential entry point to a continuum of prevention, health care, and social services that improve the quality of life and the length of survival for persons with HIV (1). Recent findings show significantly greater health benefits for persons who start antiretroviral therapy (ART) earlier (2). Persons with HIV who receive appropriate treatment, monitoring, and health care also reduce their chances of transmitting HIV to others (3). The key to HIV treatment, care, and prevention is learning one’s status through testing. In 2011, an estimated 1.2 million persons were living with HIV infection in the United States; an estimated 86% were diagnosed with HIV, 40% were engaged in HIV medical care, 37% were prescribed ART, and 30% achieved viral suppression (1). This issue of MMWR includes a report presenting estimates of the prevalence of diagnosed and undiagnosed HIV infections by state during 2008–2012. Additional information on National HIV Testing Day is available at http://www.cdc.gov/features/HIVtesting. Basic testing information for consumers is available at http:// www.cdc.gov/hiv/basics/testing.html. Additional information on HIV testing for health professionals is available at http://www.cdc.gov/hiv/testing. CDC’s guidelines for HIV testing of serum and plasma specimens are available at http://www.cdc.gov/hiv/testing/laboratorytests.html. References 1. Bradley H, Hall HI, Wolitski RJ, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR Morb Mortal Wkly Rep 2014;63:1113–7. 2. National Institute of Allergy and Infectious Diseases. Starting antiretroviral treatment early improves outcomes for HIV-infected individuals. Available at http://www.niaid.nih.gov/news/newsreleases/2015/Pages/START.aspx. 3. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493–505.
H. Irene Hall, PhD1; Qian An, PhD1; Tian Tang, MS2; Ruiguang Song, PhD1; Mi Chen, MS1; Timothy Green, PhD1; Jian Kang, PhD3 (Author affiliations at end of text)
Persons unaware of their human immunodeficiency virus (HIV) infection contribute nearly one third of ongoing transmission in the United States (1). Among the estimated 1.2 million persons living with HIV in the United States in 2011, 14% had undiagnosed infections (2). To accelerate progress toward reducing undiagnosed HIV infection, CDC and its partners have pursued an approach that includes expanding HIV testing in communities with high HIV infection rates (3). To measure the prevalence of diagnosed and undiagnosed HIV infection for the 50 states and the District of Columbia (DC), CDC analyzed data from the National HIV Surveillance System. In 42 jurisdictions with numerically stable estimates, HIV prevalence in 2012 ranged from 110 per 100,000 persons (Iowa) to 3,936 per 100,000 (DC). The percentage of persons living with diagnosed HIV ranged from 77% in Louisiana to INSIDE 663 Identifying New Positives and Linkage to HIV Medical Care — 23 Testing Site Types, United States, 2013 668 Outbreaks of Illness Associated with Recreational Water — United States, 2011–2012 673 State Tobacco Control Program Spending — United States, 2011 679 Notes from the Field: Measles Transmission in an International Airport at a Domestic Terminal Gate — April–May 2014 680 QuickStats
Continuing Education examination available at http://www.cdc.gov/mmwr/cme/conted_info.html#weekly.
U.S. Department of Health and Human Services Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report
≥90% in Colorado, Connecticut, Delaware, Hawaii, and New York. In 39 jurisdictions with numerically stable estimates, the percentage of HIV cases with diagnosed infection among men who have sex with men (MSM) ranged from 75% in Louisiana to ≥90% in Hawaii and New York. These data demonstrate the need for interventions and public health strategies to reduce the prevalence of undiagnosed HIV infection. Because the percentage of persons with undiagnosed HIV varies by geographic area, efforts tailored to each area’s unique circumstances might be needed to increase the percentage of persons aware of their infection. HIV surveillance data for persons aged ≥13 years from 50 states and DC reported to CDC through June 2014 were used to estimate the prevalence of diagnosed and undiagnosed HIV infection for 2008–2012. (Data for all years during the period 2008–2012 are available online at http://stacks.cdc.gov/ view/cdc/31699.) Data were adjusted for reporting delays (2), missing transmission category (2), incorrect diagnosis dates, and underreporting. Although acquired immune deficiency syndrome (AIDS) has been reportable in all jurisdictions since the early 1980s, confidential name-based HIV reporting was implemented over time in different jurisdictions. To correct for erroneous HIV diagnosis dates resulting from the reporting of prevalent cases shortly after implementation of HIV reporting, the year of HIV diagnosis was adjusted among persons who received an AIDS diagnosis before and during the first 2 years after implementation of HIV reporting in a jurisdiction. AIDS
cases were classified into two groups: 1) those diagnosed after 2 years of implementing HIV reporting (reference group) and 2) all other AIDS cases. In both groups, cases were stratified by year of AIDS diagnosis and vital status in December 2012. To ensure the same distribution of year of diagnosis in both groups, the distribution of year of HIV diagnosis in the reference group was used to adjust the year of HIV diagnosis of AIDS cases in the second group, by randomly distributing cases to earlier years in which the number of HIV diagnoses was less than expected and separately by jurisdiction of residence at AIDS diagnosis. Similarly, to adjust for underreporting of the number of HIV diagnoses before and during the first 2 years of implementation of HIV reporting, all HIV cases were classified into two groups: 1) HIV diagnoses after 2 years of implementing HIV reporting, or in jurisdictions with HIV reporting before 2000* (reference group) and 2) all other HIV cases. In both groups, cases were stratified by year of HIV diagnosis and AIDS status, both at diagnosis and at the end of study period. The year of HIV diagnosis among cases of AIDS diagnosed during the same calendar year in the reference group was used to adjust the number of nonsimultaneous HIV and AIDS diagnoses (among persons with disease never classified as AIDS, to maintain the actual number ever classified as AIDS) in the * Except Texas and Florida, which reported few HIV cases diagnosed before 1999 and 1997, respectively.
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2015;64:[inclusive page numbers].
Centers for Disease Control and Prevention
Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science Joanne Cono, MD, ScM, Director, Office of Science Quality Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services
MMWR Editorial and Production Staff (Weekly) Sonja A. Rasmussen, MD, MS, Editor-in-Chief Charlotte K. Kent, PhD, MPH, Executive Editor Jacqueline Gindler, MD, Acting Editor Teresa F. Rutledge, Managing Editor Douglas W. Weatherwax, Lead Technical Writer-Editor Teresa M. Hood, MS, Jude C. Rutledge, Writer-Editors
Martha F. Boyd, Lead Visual Information Specialist Maureen A. Leahy, Julia C. Martinroe, Stephen R. Spriggs, Brian E. Wood, Visual Information Specialists Quang M. Doan, MBA, Phyllis H. King, Terraye M. Starr, Information Technology Specialists
MMWR Editorial Board Timothy F. Jones, MD, Nashville, TN, Chairman Matthew L. Boulton, MD, MPH, Ann Arbor, MI Virginia A. Caine, MD, Indianapolis, IN Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA David W. Fleming, MD, Seattle, WA William E. Halperin, MD, DrPH, MPH, Newark, NJ
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MMWR / June 26, 2015 / Vol. 64 / No. 24
King K. Holmes, MD, PhD, Seattle, WA William L. Roper, MD, MPH, Chapel Hill, NC Rima F. Khabbaz, MD, Atlanta, GA Patricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WI William Schaffner, MD, Nashville, TN
Morbidity and Mortality Weekly Report
second group of HIV cases so that the proportional distribution of same-year HIV and AIDS diagnosis was the same in both groups. This adjustment was done by jurisdiction of residence at HIV diagnosis. Individual adjustment weights were assigned to each case and combined with reporting delay weights for HIV diagnosis, AIDS diagnosis, and death, so annual numbers of HIV diagnoses, same-year AIDS diagnoses, and deaths could be obtained for any subpopulation. Using the estimated annual number of HIV diagnoses and the severity of disease at diagnosis (i.e., whether the infection was classified as AIDS in the same calendar year the HIV diagnosis was made), a back-calculation model was fitted to estimate HIV prevalence, based on estimated cumulative HIV incidence (2). The overall HIV prevalence estimate was calculated by subtracting the estimated cumulative number of deaths that had occurred among those infected by the end of a given year from the estimated cumulative number of HIV infections. The estimated undiagnosed HIV prevalence was calculated by subtracting the estimated number of diagnosed HIV infections in living persons from the number of persons included in estimated overall HIV prevalence. Estimates for jurisdictions with an average of 1,000 and to the nearest 10 for numbers
